Tobacco smoking is the major cause of premature death among men in the CCEE/NIS. Reliable information on smoking prevalence and tobacco use is scarce, but the overall evidence points to two different patterns: a traditional and a high prevalence pattern. The traditional pattern dominates in the NIS and some of the CCEE, and is characterized by a high smoking rate in men (about 50%) and a low rate in women (10%). Smoking by women, however, is increasing, starting with the younger age groups. The high prevalence pattern found in the Czech Republic, Hungary and Poland, for example, shows a high smoking prevalence in women (about 25%) in addition to a high prevalence in men. Predictions made in 1990 indicated further increases or stable tobacco consumption in the CCEE/NIS by the year 2000, in contrast with the steady decrease in western European countries. When smoking is combined with other types of harmful health behaviour and environmental influences, the result is some of the highest mortality rates from lung cancer and other diseases in the world. This situation has caused severe concern in public health professionals in many of the affected countries, but not in the public and policy-makers. The fundamental changes in social and economic structures have both improved and decreased opportunities to promote nonsmoking. In the short term, the negative influences seem to dominate, although some countries, such as Lithuania and Poland, are now introducing their first realistic policies on tobacco. In most countries, however, tobacco control has to compete with other issues for priority on a crowded public health agenda.(ABSTRACT TRUNCATED AT 250 WORDS)